Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017

Huong Luu; Svetla Slavova; Patricia R Freeman; Michelle Lofwall; Steven Browning; Emily Slade; Heather Bush

doi:10.1016/j.drugalcdep.2019.107606

Association between buprenorphine/naloxone and high-dose opioid analgesic prescribing in Kentucky, 2012-2017

Drug Alcohol Depend. 2019 Dec 1:205:107606. doi: 10.1016/j.drugalcdep.2019.107606. Epub 2019 Oct 3.

Authors

Huong Luu¹, Svetla Slavova², Patricia R Freeman³, Michelle Lofwall⁴, Steven Browning⁵, Emily Slade⁶, Heather Bush⁶

Affiliations

¹ Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA.
² Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA. Electronic address: ssslav2@email.uky.edu.
³ Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA; Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA.
⁴ Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA.
⁵ Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.
⁶ Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.

PMID: 31606590
DOI: 10.1016/j.drugalcdep.2019.107606

Abstract

Introduction: Buprenorphine/naloxone treatment is a highly effective treatment for opioid use disorder decreasing illicit opioid use and both all-cause and opioid-involved overdose mortality. The purpose of this study was to investigate the relationships between buprenorphine/naloxone prescribing and high-dose opioid analgesic prescribing (HDOAP) over time.

Methods: This longitudinal study used 2012-2017 Kentucky All Schedule Prescription Electronic Reporting data and cross-lagged structural equation analysis. For each quarter-county observation, HDOAP rate (per 1,000 residents with opioid analgesic prescriptions) was used to predict buprenorphine/naloxone prescribing rate at the next quarter, and simultaneously buprenorphine/naloxone prescribing rate was used to predict HDOAP at the next quarter, accounting for baseline socioeconomic status, medical needs for opioid analgesics, and heroin availability.

Results: On average, HDOAP rates in Kentucky decreased by more than 10% (p < .0001) and buprenorphine/naloxone prescribing rates increased by more than 5% (p < .0001) per quarter over the study period. Every one-per-thousand higher HDOAP rate in an earlier quarter was associated with a 0.01/1,000 increase in the buprenorphine/naloxone prescribing rate in a later quarter (p = .009). Conversely, a one-unit higher buprenorphine/naloxone prescribing rate in an earlier quarter was associated with a 0.01/1,000 reduction in the HDOAP rate in a subsequent quarter (p = .017).

Conclusions: Our results indicate a significant reciprocal relationship between HDOAP and buprenorphine/naloxone prescribing and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing HDOAP. Future studies on buprenorphine/naloxone treatment expansion should take into account this bi-directional association in the context of longitudinal data and evaluate for public health benefits beyond the reduction of HDOAP.

Keywords: Buprenorphine/Naloxone; High-dose opioid analgesic prescribing; Methadone; Opioid use disorder; Prescription drug monitoring program.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Analgesics, Opioid / therapeutic use*
Buprenorphine, Naloxone Drug Combination / therapeutic use*
Drug Prescriptions / statistics & numerical data*
Female
Heroin
Humans
Kentucky
Latent Class Analysis
Longitudinal Studies
Male
Opiate Substitution Treatment / statistics & numerical data*
Opioid-Related Disorders / drug therapy*

Substances

Analgesics, Opioid
Buprenorphine, Naloxone Drug Combination
Heroin